Breast Lift and Augmentation

Breast Lift and Augmentation - Page

Breast lift surgery is designed to improve the appearance of sagging or ptotic breasts. The Breast Lift and augmentation restores or adds volume to the breasts with saline or silicone breast implants. Dr. Rex Moulton-Barrett performs combination breast lift and augmentation in Alameda and Brentwood to increase breast size while improving breast shape.

The etiology is varied and can be due to several components but gravity seems to be a common factor. Younger patients are more prone to ptosis if breast size is excessive or if the skin is thin. Ptosis in middle-aged patients usually is due to postpartum changes; the breast skin is stretched during lactation or engorgement, and afterward the breast gland atrophies, leaving loosened skin. Finally, in postmenopausal patients, further atrophy, gravity, loss of skin elasticity due to age, and weight gain are factors in creating breast ptosis.

In most instances, breast mastopexy has no true medical indication and is performed primarily for aesthetic reasons. The main exception to this is in postmastectomy reconstruction, when performing a mastopexy often is essential to achieving symmetry.

While descriptions of reduction mammoplasty were reported as early as Paulus of Aegina (625-690 AD), not until the late 19th century was emphasis placed on correcting ptosis of the breast. Much of the history of mastopexy parallels breast reduction, both attempt to alter the shape of the breast and skin envelope, and elevate the breast.

Wise (1956) defined the preoperative geometric marking system most commonly used today. Gonzalez-Ulloa (1960) first advocated mastopexy with augmentation for ptosis with hypoplasia or atrophy. Benelli (1990) reported the use of the periareolar round block or purse string mammoplasty. Hall-Findley (1999) used a medial-based pedicle modification of the vertical scar approach first described by Lassus (1970) as superior pedicle and popularized by Lejour (1994) with the use of breast liposuction.

Mastopexy presents one of the greatest challenges to the breast surgeon but previous techniques have drawbacks. Although breast implants may provide the upper pole projection patients often desire, they present specific risks and complications.

Mastopexy Augmentation: Superior Crescent

For patients with mild sagging, excess breast skin in the upper half of the breast, requesting no more than 2cm of nipple/areola lift and a normal amount of skin in the lower half, a semi-circular incision is made on the upper border of the areola. A crescent shaped piece of skin is removed, and when the skin edges are sewn back together, the nipple and areola are raised slightly (1 to 2 cms). A crescent mastopexy is best for women with only mild breast ptosis (sagging).

Patient Superior Crescent Mastopexy and Augmentation before and after photos

Mastopexy Augmentation: Anchor Incision

The balance between opposing forces of removal of excess and ptotic breast skin and the addition of breast volume is a careful one. The ultimate goal is to design the breast with sufficient skin tension to fight the tendency of recurrent ptosis and laxity without jepardizing blood and nerve supply. Please refer to the augmentation section for specific questions regarding augmentation in general. The choice of type of implant is an individual one. If the patient has a significant history of breast feeding, I prefer to use a textured implant. I believe that the textured surface has a lower risk of forming a capsular contracture. Breast feeding may pose a risk of colonization with local skin flora within the breast tissue. It is for this reason that breast augmentation should not be performed within 6 months of breast feeding. If the lateral and inferior poles of the breast have thin skin and the breast tissue itself lacks density, it is probably better to use a silicone jel implant in order to avoid early or later rippling. Rippling refers to the feeling of a palpable irregular edge of the implant through the skin. It is for this reason that the textured round silicone implants have become increasingly popular over the last year in my practice.

Patient Mastopexy Augmentation: Anchor Incision before and after photos